本文在简要总结分析我国医疗保障筹资面临的困难和矛盾基础上,提出健全稳健可持续医保筹资运行机制的具体思路。改革现行职工基本医疗保险按工资为基数缴费为统筹考虑工资性收入、财产性收入、经营性收入和转移性收入核定,并考虑家庭收入和财产核定,逐步实施按家庭缴费。扩大医疗保障资金筹资渠道,建立应对人口老龄化及重大疫情等的医疗保障风险储备基金,除了划转部分国有资本充实医疗保障资金,应将烟酒税、环保税、个人所得税等按一定比例补充医保基金。探索通过发行医疗保障彩票、债券等充实医保资金。从根本上解决被征地农民失地后的土地权益,保证他们拥有持续的缴费能力。通过建立更高质量、更可持续、更加公平、更强调节收入分配功能的医疗保障筹资运行机制,促进共同富裕。

Based on a brief summary and analysis of the difficulties and contradictions faced by China's healthcare security financing, this paper puts forward specific ideas to improve the stable and sustainable healthcare security financing operation mechanism. Reform the current basic medical insurance for employees to pay according to the salary as the base. In order to make overall consideration of the verification of wage income, property income, operating income and transfer income, and consider the verification of family income and property, pay according to the family gradually. Expand the financing channels of healthcare security funds and establish a healthcare security risk reserve fund to deal with healthcare security funds, tobacco and alcohol tax, environmental protection tax and personal income tax should be supplemented with healthcare insurance funds in a certain proportion. Explore ways to enrich healthcare security funds by issuing healthcare security lottery tickets and bonds. Fundamentally solve the land rights and interests of land expropriated farmers after losing their land, and ensure that they have sustainable payment ability. We will promote common prosperity by establishing a higher quality, more sustainable, more equitable and stronger healthcare security financing operation mechanism that regulates the function of income distribution.